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Book Review   |    
Jeffrey L. Geller
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.9.1342
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by Theodore Nadelson, M.A., M.D.; Baltimore, Johns Hopkins University Press, 2005, 208 pages, $25

Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical School, Worcester.

Dear Ted, when I first received Trained to Kill as the book review editor, I immediately considered assigning the book to myself. My second thought, almost as immediate as my first, was that I couldn't do that. How, I asked myself, could I write an objective review of a posthumously published book written by a psychiatrist who had been my supervisor during my residency at Beth Israel Hospital in Boston and whom I held in high regard? On the other hand, who would I trust with a former mentor's last professional contribution? My hesitation was not lengthy because I thought if you and I were in a position to have a conversation about my quandary, you would have told me to go ahead and do the review and to do so in an honest, straightforward fashion. And hence, I have done the review and hope that I have lived up to what would have been your expectations.

Ted, Trained to Kill is a lyrical book about soldiers at war. Although it might sound oxymoronic to put lyrical and war in the same phrase, the sensitivity and empathy you show to the Vietnam veterans who are the subject of this book is so compelling—and the pain you shared with them so evident—that any reader will experience no paradox in making his or her way through the pages of a kind and gentle book about soldiers at war.

The flow of Trained to Kill is sometimes choppy. Some might think, Ted, that this comes from the fact that a close friend, your wife, and your son—the first two psychiatrists, the last an attorney—had to complete the editing of your text after your death in October 2003. That certainly may contribute to this effect. But the book is written very much as you thought and taught: bursts of brilliance surrounded by verbal meanderings that always needed to be attended to carefully in order not to miss the next enlightened burst.

At a time when the world seems to have soldiers at war in so many areas, when people in the United States are exposed to news of death and destruction in Afghanistan and Iraq on an almost daily basis, when we intermittently hear of the devastation of attacks in Great Britain, India, Kashmir, and throughout the continent of Africa, when threats to world peace rise from cultures as disparate as North Korea, Israel, and Palestine, Trained to Kill is powerful and painful. Ted, you get inside soldiers as has rarely been done in print.

What is most remarkable about Trained to Kill is the explanation of how attached soldiers—particularly men, but even women—are to the acts of war themselves. The struggle to avoid being a "pussy," the achievement of manhood through trial and endurance, the transformation from boy to man through death and war, the process of military training to "wrest the soldier out of the civilian," the overcoming of a natural resistance to killing, the fact that past killing in war can be a pleasurable reminiscence, the notion that "taking a man with a knife is often experienced with sexual excitement," the thought that combat can be "the most intense high," the concept that soldiers have a "most inevitable drive toward vengeance," and the construct that freedom comes with release from "restriction on aggression" are all perspectives that you bring, Ted, to the reader by being the soldier's messenger. No author has quite done the same. It took a psychiatrist to sit with these men and women and listen without the expression of horror, without condemnation, and without judgment. This was done in a way that perhaps no one other than a psychiatrist could have done. For it took not only the understanding of these former soldiers' psyches but also an understanding of their physical injuries and scars.

You tell us, Ted, that "War is inherently traumatic because it dehumanizes its participants." You explain this throughout the pages of Trained to Kill. It is unfortunate that those who make decisions about going to war or not ending war have not yet read your book. They may well be familiar with a Vietnam slogan you quote, "Yea, though I walk in the shadow of the valley of death, I fear no evil because I am the meanest motherfucker in the valley." Unfortunately, it would appear that too many in authority fail to understand exactly what this slogan may mean or the costs to the individuals who endorse it.

Many other lessons are in Trained to Kill. An interesting one is that for young soldiers the bonds they develop in training, and then in combat, may be the closest relationships they ever have, both before their experience as a soldier and after. Trained to Kill is derived from your experiences, Ted, with psychiatric patients at the Boston Veteran's Administration Hospital. Perhaps they are not a representative group. Maybe others have done better with their relationships after their Vietnam experience, but there is no doubt, as you have indicated, that war is mentally damaging.

No professional or paraprofessional group currently delivers care and treatment to individuals with mental illness who would not benefit from reading Trained to Kill. On one level it is about psychiatrically impaired Vietnam veterans; at another level it is about fundamental relationships, how they form, what they depend on, and how they can be perverted. Trained to Kill provides a developmental perspective on how boys become men who kill, with a coda on how girls become women who do the same. Trained to Kill sheds light on violence perpetrated by individuals who have never been soldiers, such as individuals with chronic mental illness disinhibited by substances and alcohol. The book also considers individuals who might otherwise have difficulty with relationships by highlighting the powerful bonding power of mutually endorsed destruction. Although the subject of terrorism is never specifically addressed, Trained to Kill sheds substantial light on terrorist groups. This book does for the fighting forces what Irving Goffman's Asylum did for psychiatric institutions. It prods us to educate ourselves in new ways and to use that education to fundamentally alter centuries-old institutions.

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